Abstract 358: Coronary Features in Different Subsets of Out-of-Hospital Cardiac Arrest

Abstract

Introduction: Coronary artery disease (CAD) is the leading cause of out-of-hospital cardiac arrest (OHCA) which is usually triggered by acute coronary event. Hypothesis: CAD is more complex if acute coronary event is associated with OHCA. CAD complexity progressively increases from patients with reestablishment of spontaneous circulation (ROSC) to patients with refractory OHCA. Aims: To investigate CAD features in different subgroups of OHCA and compare them to patients with acute coronary syndrome without OHCA. Methods: Consecutive conscious and comatose OHCA with ST-elevation myocardial infarction (STEMI) after ROSC and patients with refractory OHCA undergoing veno-arterial extracorporeal membrane oxygenation (E-CPR OHCA) were compared to STEMI without OHCA (STEMI no OHCA). Results: Between 2016 and 2022, 71 conscious OHCA, 157 comatose OHCA, 50 E-CPR OHCA and 101 randomly selected STEMI no OHCA underwent immediate coronary angiography. Acute culprit lesion was documented less often in OHCA subsets (88.1% vs 97%; p=0.009) but complete occlusion was more prevalent (68.8% vs 58.4%; p=0.038) (Figure A) . Incidence of multivessel disease, > 50% unprotected left main stenosis, and presence of > 1 chronic total occlusion progressively increased from STEMI no OHCA to E-CPR OHCA. This was reflected in baseline SYNTAX score which was 5.6 in STEMI no OHCA,10.2 in conscious OHCA, 13.4 in comatose OHCA and 26.8 in E-CPR OHCA (p<0.001) (Figure B) . There was a linear correlation between SYNTAX score and delay to ROSC (r 2 =0.61; p<0.001) (Figure C) . Baseline and residual SYNTAX scores were among independent predictors of 5-year survival which was significantly decreased in comatose (56.1%) and E-CPR (36.0%) OHCA (Figure D) . Conclusion: OHCA is associated with increased incidence of acute coronary occlusion and progressive complexity of CAD from conscious OHCA to E-CPR OHCA. Severity of CAD is associated with increased delays to ROSC and decreased long-term survival.